The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Kevin Crezee1, Bradley Yoder2, Donald Null2; 1Respiratory Care, Primary Childrens Medical Center, Salt lake City, UT; 2Department of Pediatrics, University of Utah, Salt Lake City, UT

BACKGROUND: Humidified high flow nasal cannula (HHFNC) use is increasing in the NICU despite limited evidence. Unpredictable pressure delivery suggests caution in using HHFNC for support of infants at risk of volu/baro-trauma. One such population would appear to be infants with relative lung hypolasia, such as congenital diaphragmatic hernia (CDH). OBJECTIVE: Evaluate the relative efficacy and safety of HHFNC in a cohort of infants with CDH, as well as factors associated with failure or adverse outcomes. DESIGN/METHODS: A quality improvement tool was developed to prospectively monitor HHFNC use outside of a randomized controlled trial in 3 NICU's. Infants with CDH were specifically excluded from the radnomized trial. Between Oct 2006 and Jul 2010, 52 of 61 CDH infants operated on survived to extubation; 39 (75%) were managed with HHFNC. Pre-HHFNC respiratory support, indications, effectiveness, duration and complications of HHFNC use were assessed. Data are shown as median (25-75%) or percent. RESULTS: HHFNC start age was 15.6 (8.4-27.4) d, duration 7.8 (3.7-13.8) d, and start flow 5.0 (4.0-6.0) lpm. At time of HHFNC start, 24 (62%) infants were on ventilator support, the remainder were on CPAP or Nasal IMV; 21 (54%) were on inhaled NO therapy. Failure of HHFNC occurred in 6/39 (15%) of which 3 required return to ventilator support; subsequentially all 6 were successfully managed with HHFNC. Failure typically occurred within 5 days of start of HHFNC related to increasing FiO2 and/or distress. Failure was associated with prior ECMO therapy (5/12 v 1/27, P=0.007) and "need" for a maximum NC flow rate >/= 6 lpm (6/19 v 0/20, P=0.008), but not related to type of support prior to HHFNC (vent 2/24 v non-invasive 4/15). None of the CDH infants developed air leak or had radiographic evidence of lung over-inflation during HHFNC therapy. CONCLUSIONS: Despite concerns over potential pressure related lung injury, HHFNC can be effectively and safely applied in the post-extubation support of most infants with congenital diaphragmatic hernia and relative lung hypoplasia.
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